Story at a glance
- U.S. health care costs top $10,000 per person per year — double what many other nations pay.
- Norway has nearly twice as many physicians.
- Life expectancy is falling and suicides are increasing.
America has the highest suicide rate and the lowest life expectancy compared to other wealthy nations while spending nearly twice as much on health care. It also has the highest rates of preventable deaths from causes such as diabetes, hypertensive diseases and certain cancers, according to a new Commonwealth Fund report, “U.S. Health Care from a Global Perspective, 2019.“
The report highlights the fact that U.S. suicide rates are double those of the United Kingdom. It found that on average Australians live four years longer, have nearly 20 percent fewer suicides and spend about half as much on health care as the U.S. does. Despite spending much less, Australians see physicians twice as often as Americans.
“We spend more and get less for it,” says Dr. David Blumenthal, president of Commonwealth Fund, a New York City-based foundation focused on promoting a high performing health care system.
The U.S. has the world’s most expensive health care system, but it’s not well understood how poorly it performs overall, Blumenthal said in an interview. Cost is a major barrier to proper care. In other countries, there is no cost to the patient for primary care. In the U.S., even with employer-sponsored health insurance, ever higher deductibles keep people from getting the care they need, he says.
Critical shortage of primary care physicians
Another major factor is the lack of primary care physicians, he said. “I have to scramble to find primary care physicians for family members, and I have a lot of contacts.”
The study used data from the 2019 release of health statistics compiled by the Organisation for Economic Co-operation and Development (OECD), which tracks and reports on a wide range of health system measures across 36 high-income countries.
Surprisingly, the U.S. has relatively few practicing physicians: 2.6 for every 1,000 people compared to more than 4 for every 1,000 people in Norway, Germany, Sweden and Switzerland. U.S. medical schools are expanding, but part of the problem is that there are too many expensive specialists and too few primary care physicians, says Blumenthal.
And despite having fewer doctors, U.S. health spending totals more than $10,000 per person per year, mainly due to private insurance costs (premiums and employer-sponsored coverage) the report found. At $4,092 per capita, American private spending is more than five times higher than Canada, the second-highest spender and more than six times that of Australia. The amount of public health care spending in the U.S. is similar to many other countries.
The lack of access to primary care results in one of the highest rates of hospitalizations for preventable conditions and the highest rate of avoidable deaths. Hospitalizations related to diabetes and hypertension, considered preventable with sufficient access to primary care, are approximately 50 percent higher in America than the OECD average.
Death rates on the rise
While life expectancy continues to increase in other wealthy countries, in the U.S. it stopped increasing in 2011 and has been falling since 2014, according to a study recently published in the medical journal JAMA.
"Working-age Americans are more likely to die in the prime of their lives," said lead author Dr. Steven Woolf, director emeritus of the Virginia Commonwealth University.
The study revealed that West Virginia, Ohio, Indiana and Kentucky, as well as the northern New England area, including New Hampshire, Maine and Vermont, saw the largest relative increases in deaths. "The notion that U.S. death rates are increasing for working-age adults is particularly disturbing because it is not happening like this in other countries," Woolf said in a statement.
Opioid and other drug overdoses alone took 70,237 lives in 2017, the highest number ever recorded for a single year. The last decade has also seen a 35 percent increase in suicides. A lack of mental health screening, inadequate investment in social services, and the inability of many people to pay for mental health treatment are all factors for this increase, the Commonwealth report found.
America’s health care system does excel when it comes to preventive measures such as flu vaccinations and breast cancer screenings. The five-year survival rate for breast cancer is highest among high-income countries but the lowest when it comes to cervical cancer.
The Affordable Care Act has improved access by insuring more people and other aspects, but U.S. health care has a long way to go to match international standards, says Blumenthal.
To that end, the report makes three main recommendations:
Promote incentives to use effective care and cut down on wasteful care. Recent studies suggest that as much as $935 billion in annual U.S. health care spending goes to ineffective tests and treatments that provide minimal benefit.
Reduce health care costs. Lowering health care prices is likely to have the greatest impact on health spending. A drug may cost five times more in Buffalo, N.Y., than an hour’s drive away in Toronto.
Invest in primary care. Making access to affordable care more readily available and strengthening primary care could make a big difference for the people who need the most care.